### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R SAIP# ; 2278 7 DATE ; 1/1 5 ADDRESS : 51 9 S 2 4 A V REMEDIATIO N CONTRAaOR : PRUDEN T TECHNOLOGIES . IN C YEAR : 20l b 

### SOI L REMEDIATIO N PROPERT YFIL E FOLDE R DOCUMENT S n i PR E AN D POS T VIDE O O F PORPERT Y(DVD ) m EXECUTIV E SUMMAR Y a EPA-PROVIDE D PROPERT YSKETC H / SIGNE D ACCES S AGREEMEN TFOR SUBJEC TPROPERT Y D SIGNE D ACCES S AGREEMENT(S ) FOR ADJACEN TPROPERT Y RESTORATIO N AGREEMEN T D SETTLEMEN TDOCUMENTS (I.E. , FOR DAMAG E O R T O REPLACE PLANTS , ETC. ) E CONFIRMATIO N DAT A PHOTOGRAPH S 

# I AS-BUIL TSKETC H Q SATISFACTOR YRESTORATIO N SIGNE D B YPROPERT YOWNE R o f PROPERT YCLOSE-OU TCHECKLIS T SIGNE D B YEP A D DESCRIPTIO N O F AREA S NO TMEETIN G RO D CLEANU P CRITERI A

• UTILIT YCLEARANCE S

• PROPERT YINFORMATIO N FRO M DOUGLA S COUNT YASSESSOR'S OFFIC E 

# • D 

# • t\^^^ ^ SIGNATUR E DAT E 3023744 3 

# 'J^ niui i IIIIII I Superfun d

### PROPERT Y SUMMAR Y Date : /15/201 0 Omah aLeadSite Remedial Actio n Contrac t #EP-R7-07-0 6 TO# l Mont hof : Propert y Address ; 519S24A V A . EXECUTIV ESUMMAR Y A. 1 Issue s Encountered : NON E A. 2 Issue s Resolved : NON E A. 3 Uniqu e Findings ; NON E A. 4 Othe r Relevan t Information : NON E CONFIRMATIO N SAMPLIN GDATA/RESULTS : F 2 = 31 0 PP M @ 2" ; N O EASEMENT ATTACHMENT S 1 ) Propert y sketc hprovidedb y EP A pursuan t to contract specification s 2 ) SignedAcces s Agreemen t including acces s agreement s requiredfo r crossing othe r propertie s 3 ) Pre-Excavation digita l vide o clip/photograph s 4 ) Post-Excavation digita l vide o clip/photograph s 5 ) Documentation - CompletedClose-ou t Checklis t 6 ) As-Built sketch i ) Shal l includ e fina l lea dlevel s v ) Legen d ii ) Contamination lef t behindarea s vi ) Contractor identification iii ) Propert y addres s vii ) Dat e iv ) BVI D numbe r 7 ) Othe r items t o b e includedi n the individua l propert y file, if available , o r obtainedinclude : i ) Pre-excavation agreemen t detail s (ifan y ar e mad e wit hthe propert y owner ) ii ) Propert y Statu s For msignedb y propert y owne r iii ) Excavation digita l vide o i n MPEG , WM V (Window s Medi aVideo ) or SW F(FlashPlayer ) forma t and/o r photograph s iv ) Signedfor mverifying satisfactor y restoration v ) Description of area s not meeting InterimRO D cleanu p criteria .

TECHNOLOGIES . INC .Fin d Record 

### Backfill :

Sampl e Area : 2278 7 - 51 9 S 2 4 A V Owner : D Owne rOccupie d 

### Owne rName : jSERVIC E AMUSEMEr ^

LL C Owne rAddressi : IC/ O JEROM E w m Owne rAddress2 : J52 2 S 2 4 S T City : 

### State : Zi p Code : )OMAH A " " [N E 168102 - Owne rPhon e Alternat e Phone :

Contract : Contractor : |PRUDENT2010_ S Contrac t Optio n JOPTION 2 Remediatio n QueryLea d Remainin g Quer y] Propert yDamag e Query


### Use rProvide d Owne rInformatio n Owne rName : 

# r Owne rAddress : 

# 1 City : State : Zi p Code : 

# r^ ' 1 1 Owne rPhone : Alternat e Phone : 

# 1 ( 

### Assessment : Qualifyin g Grou p ^40 0 Assessment Ma xXRF Valu e f 501.92 Resident : Residen t Name : ! Propert yAddress : 151 9 S 2 4 A V Zi p Code : 168105- Residen t Phon eTECHNOLOGIES , INC . 

# EP A Propert y Clos e Ou t Propert y # : X^^' ^ Propert y Address : 5 ( "^ ^ 7 - ^ f -^^^^ ^ Date/Time : Owner' s Name : "^^^OTIA ^ 

### u i \- ^ Quad s Excavated : F^ — Contracto r Group : Pruden t Technologies , Inc. , Excavatio n Genera l Ye s N o 1 . I f necessary , wer e th e correct quadrant(s ) excavatedandrestored ? / 2 , I f necessary , wer e th e correct area s o f drip zone excavatedandrestored ? / Gradin g Sodan dVegetatio n Ye s N o 1 Doe s the gradin g aroundthe perimete r ofth e hous e in excavatedarea s generally slop e awa y / fro mthe house' ' 2 Has sodbeen lai din all area s tha t wer e excavated ? / Tl

. Doe s th e sodappea r to b e generall y health y andgrowing ? (Onl y evaluate i f inspecte dal a3 0 da

y time period) / 4 Ar e soddedarea s generaU y fim i an devenl y graded ? / 5 .Ar c tli e jomt s between th e sodstrip s generally tight ? (Onl y evaluat e i f inspecte da t a3 0 da y lim e period) / 6 .

Wa s th e propert y grade dsuc htlia t wate r will no t pool o n the property ? / 7 .

Wa s damag e t o landscapin g o r plan t material s avoided ? / Gates , Fence s an dRetainin g Wall s Ye s N o 1 D o gate s ope n andclos e freely'. ' (I f applicabie ) / 2 .

Wer e all gate s o r fence s take n dow n durin g restoratio n activitie s reinstalled ? (I f apphcable ) / 3 Was damag e t o gate s or fence s avoided ? (I f applicable ) / 4 Was damag e to retainin g wall s avoided ? (I f applicable ) / Foundation , Sidin g an dGutter s Ye s N o 1 Wa s damag e t o the siding o r trimavoided ? Wa s damag e lo the foundation avoided ? - ^ 

### Was damag e t o window s avoided ? Wa s damag e t o window s o r doo r screen s avoided ? 5 .Wa s damag e lo downspout s o r downspou t extension s avoided ? 

# y Sidewalk s an dDriveway s (Concrete ) Ye s N o Wa s damag e t o drivewa v surface s avoided' ' 1 . Wa s damag e t o walkwa y surface s avoided ? I

## Ownn^ s comments :

Inspectio n notes :

rfMfi ^ 

## c ^ ^..1- '



## Remova l andrestoratio n activate s complete includin g th e 30-da y so dwarranty . EP A Representativ e 0o n >j£ ^ Date : ijisj nEOINOLOGIES . INC 

### A S - BUIL T DRAWIN G OL S #2278 7 Dat e Excavated : 10/29/201 0 

### OMAH A LEA D SUPERFUN D SIT E I'SEPASigned-OffDate : 2278 7 Exterio rPain t Omah a Lea d Sit e Owne rNam« ; ID AFELLMA N • Goo d Sit e Sketc h Address : 51 9 S 2 4 A V • Poo r Phone : H 402-342-040 0 W : [~ ) Not pain l Sampl e Numbe r Lea d Concentratio n Sampl e Collecte d LA B Firm . Sample s Collecte d P'& AHJ/'TI. . RYASCPXA-2278 7 F l pp m 

### B D Dat e IC--/ C ­ ^ RYBSCPXA-2278 7 F 2 pp m 

### 0 D Time : ir'i i RYCSCPXA-2278 7 RYDSCPXA-2278 7 B l B 2 ''f ^ 

## ?5 S pp m pp m 

### 0 0 D D Sample s Analyze d pp m 

### D D XR F Unit : /< g 3 7 Book : ? 3 5 _-RaZSCEXA-22?85 ^ G^ - pp m 

### D D Date : I \-10-Of • •RPZSGr>XA-22?8 7 Pi ­ pp m 

### D D Time : AM Numbe ro f Sample s = / Staff : A^ 4 Legen d F l = Fron t Left , F 2 = Fron t Right . B l = Bac k Leff , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla y Al l quadrant s ar e a

s viewed fro m ih e street , facin g propeit y 

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WAL-.V : |KO.4 - 2 4 ,-4 v N O EASEMK M CONTRAC T# : EP-S7-10-0 5 PRUDEN TTECHNOLOGIES , INC .

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Thi i 5.ki;f:eil!r;;: s '.•ivr'--uji;e"('it i tJl c (..i-uipiciiOi ; Ol I'dlJO'va i JCiJv'jUr S ye:i'i';'irriei: ! ui i ili C btii:'v\ ' Ji.Sit;; dpi'^.tpcjTy . Th e propeit y owne:'j . .iignatm e indicate, ? iha t th e propeit v r-vy'tje r is ,=atiyfiedwit hth e restora,vj..«ii ol th e • Siibjec f piopert y a;i dtha t no item: , 'ir e )n question , now , or al a:n y iirri e in th e future , excludin g an y reini^!nni, g waira/ity ' (3 0 day. s tota) i e.iicep t thos e item s !i.ste dbel'iw , if any . Propsr!. T ffi'- Proper:!-? - .=;-.i'Jldif';'S.s ' ? ^ ] Ci C ^ U'WEr'ar ­ .PfniiRf , 

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## -O L COMMENT S O R 8PECUU . INSTRUCTIONS : (I.E . DOOS , ENTR YGATES , ETC. )

AUTHORIT YFO R ENVtROMME N fA L RSSPONS E ACHONS I Tb e aclmtie i l o b ciinptemcalc d b yEP Aunde rtU j asfcemcn l ar

e pumm t t o Sectio n 10 4 o f CERCLA . 4 3 USC . 9604 . EPA' s ligh t ofaecej s t o th e propett yi i frovide d Ib f i n Sectio n 104(e ) o f CEKCLA . 4 2 U.S . C 960S(eX >*4uc h pnvlde i enli yfbr'dOamiinui B Ib e iMa d (o rtesponia . o rokoMin s O f adcbi g 11 ^ unde r(hi * titii k o rotbcrwis e enStreia g th e pforiato m o f dt e ttte. "

BOB O W«/r i ParlDMy . Suit e 40 5 . (Sra 0 8.10^Sli«a t 424 2 Madlea l Oriv* . Sut e 425 0 Kansa n CKy , M O 6411 4 Omaha , Nabraik a SBIOT Sa n Antonio . T X 7622 9 Phone : (BIO ) 363-370 3 Phono : (402)733-146 5 Phona : (210)6224SB B Fax : (816 > 363^0 1 Fax : (402)733-166 3 Fax : (210 ) 670467 7

# \ < 

# .-J l TECHNOLOGIES , INC . 

# ^ Propert y Statu s For m Address : "Sl ^ ^ ^ ^ /W ^ Date : jOU^I( O FhoMe ; 

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Propert y Owne r Signatiuire : Pniden t EmuJo^ e / .1 

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## 2278 7 

# Iiiniiiii Exterio rPain t Nort h Arro w Omah a Lea d Sit e Owne rName : iD A FELLMA N • Goo d Sit e Sketc h Address : 51 9 S 2 4 A V • Poo r Phone : H . 402-342-040 0 W : Q Not pain t Sampl e Numbe r RYASCPXA-2278 7 RYBSCPXA-2278 7 RYCSCPXA-2278 7 RYDSCPXA-2278 7 Lead Concentratio n 

## 3 5- ^ pp m pp m pp m pp m Sampl e Collecte d 

# 0 B 0 0 LA B 

## D D D D Firm : Date : Time : Sampte s Collecte d f^t A HJ/'TI . /O-zP- ^ //•*f o Sample s Analyze d pp m pp m 

# D D 

# n D XR F Unit : Date : _ 

## /^?5 7 Book : JZ3 3 \l-W~OS ' pp m 

# D D Time : 

## Arr i Numbe ro f Sample s = / Staff : 

## LP K Legend : F 1 = Fron t Left , F 2 = Fron t Right . B 1 = Bac k Left . B2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla y Al l quacfrants are a s viewe d fro m th e street , facin g property 

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### Sampl e Collected 

# B 0 LA B 

# D D Pim r Date : 

### Time : Sample s Collecte d P'6 AHj/:rj.. _ W~/ G -:£ " 

### 11^*^ 6 RYCSCPXA-2278 7 RYDSCPXA-227S 7 S 1 S2' M 

# 3B S pp m pp m 

# 0 0 n D Sample s Analyze d pp m 

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# n XR F Uni t 

### 103 1 Book : 13 3 -—G2 ­ pp m 

# D D Date : _ 

## W-W-oS ' RPZSCr^X;' \ 22787 ­ pp m 

# D D Time : _ 

# A ^ Staff : 

## L A Numbe ro f Sample s • 

## f Legend : F 1 = Fron t Left , F 2 = Fron t Right . B 1 = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla y Al l quadrant s are a s viewe d fro m 'ti e street , facin g property

## N 

# Lega l Description : 24.3 2 X 48.6 4 ^^ ^ 

# A Printed : Oct 25 , 201 0 •i^ » vvww.dcgis.org/dogi. s

## Pag e 1 of 2

" > Creat e Anothe rTicke t Back,t o Jit b . 1 nterne t Sen d Emai l 

## YOURTICKE T NUMBERI S 2625964 . Origina l Cal l Date : 10/25/1 0 Time : 4:1 1 p m Op : SIVA1896 7 Wor k t o Begi n Date : 10/27/1 0 Time : 4:4 5 p m State : N E County : DOUGLA S Place : OMAH A Address : 51 9 Street : S 24T H AV E Twp : 15 NRng : 13 E Sect-Qtr : 21-NE-SE,22-NW-S W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : SOI L LEA D REMEDIATIO NPROJEC T Locatio n o f Work : LOCAT E ENTIR E PROPERT Y Remarks : FA X AL L CLEAR S TO : (402)733-188 3 : UNSUR E CORNER S Compan y: PRUDEN T TECHNOLOGIE S Contac t Name : SIV AJAMPAM A Phone : (402)733-118 8 Wor k Bein g Don e For : EP A Dept h o f Excavation : 6 F T Corne r Lot ; NFront : Y Rear : Y Involve s Tunnelin g o r Horizonta l Borin g ; NExplosives : N ALTS7 2 CXCAT V DOCOINF S ENERG Y LEVEL 3 MUDO l OMAHACO F 0PPDGPR 5 PAETE C QLNNEI C
Servic e Are a Contac t 

### Phon e Nunlber Utilit y Typ e ALT87 2 WINDSTREA M COMMUNICATIO N ELM LOCATIN G 

### Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 CXCAT V CO X COMMUNICATIONS , IN C HEID I 

### Day : Alt : 402934046 9 402934046 9 Emerg : 402932975 7 DOCOINF S DOUGLA S COUNT Y INFORMATIO N SERVICE S ALLA N 

### Day : 402510724 2 Alt : 402444718 8 Emerg : 402510724 2 ENERG Y ENERG Y SYSTEM S C O DAV EWOOD S 

### Day : Alt : 402346906 6 402346912 8 Emerg : 402346912 8 

## http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT.. . 10/25/201 0

## Pag e 2 of 2

LEVEL S

MUDO l

OMAHACO F

0PPDGPR 5

PAETE C QLNNE1 C LEVEL 3 COMMUNICATIONS , LL C METROPOLITA N UTILITIE S DISTRIC T CIT Y O FOMAHA TRAFFICSEWE R OMAH A PUBLI C POWE R DISTRIC T
PAETE C COMMUNICATION S

QWES T LOCA LNETWOR K N A

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N O NEE D T O CAL LOU T EMERGENC Y
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### Day : 877366834 4 Alt : 

## Emerg : 8773668344 Day : 402504782 3 Alt : Emerg : 402504797 0 Day : 402444719 7 Alt : 402444516 1 Emerg : 402444516 0 Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 Day : 800289190 1 Alt : 

## Emerg : 800289190 1 Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT.. . 10/25/201 0TBBHN< . M C 

### CONSTRUCTIO N SOLUTION S 

## SIT ESAJ^T Y HAZARD ANALYSI S -SZS . i-Jii-j ^ Address : Excavatio n Date : Crew : — BackfiU Date : —
Ite m Overhea dLine s Ga s Lin e Wate r Lin e Sewe r Lin e Septic/Leec h Fiel d Propane/Butan e Sidewal k Foundatio n Retainin g Wall s Fence s Tree s Stracture s Driveway Sprinkle r Syste m Othe r Cre w Forema n Conditio n Hazard s Correctiv e Actio n OJT* ^ 

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## Sit e Safety Offic e Date :

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### seoosios t 424 2 Itedica l Drive , Suit e 726 0 Oiirttaa , Mttirati M OT1g7 Sa n Antonio , T X 7822 9 : {Sit ) 3SS-37V 3 PhOfM : {402)733-110 8 Phone : (210)822-058 8 KfMi ) 363>^370 7 Ftax : 4402)733d«8 3 Fax : (210)«79-S57 7^

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